Computed Tomography Angiography

in Vascular Diagnostics and Imaging

Applied

Type

Modification

Confidence

95%

Created

Mar 20, 2026

Evidence

3 sources

Rationale

The section was updated to integrate the most recent major guidelines for aortic disease (2022 ACC/AHA) and peripheral artery disease (2024 ACC/AHA). These guidelines provide high-level evidence (Class 1 recommendations) for the use of CTA in planning and surveillance. Technical details like ECG-gating were refined based on these standards, and all medical abbreviations were expanded on first use as required.

Evidence

Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024. PMID: 38743805.
Verified source
PubMedDOI
Isselbacher EM, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation. 2022. PMID: 36322642.
Verified source
PubMedDOI
Writing Committee Members, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease. J Thorac Cardiovasc Surg. 2023. PMID: 37389507.
Verified source
PubMedDOI

Content Changes

* **Gold standard** for aortic disease (abdominal aortic aneurysm (AAA), TAAA,thoracoabdominal aortic aneurysm (TAAA), thoracic endovascular aortic repair (TEVAR) planning).planning) via computed tomography angiography (CTA) [@aha2022-f].
* **Technical essentials:** Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), ECG-gatingelectrocardiogram (ECG)-gating for thoracic aorta when assessing root or ascending segments,segments to minimize motion artifact [@aha2022-f], standardized contrast delivery (4–6 mL/s) with saline chaser, and iterative reconstruction algorithms to reduce radiation dose.
* **Applications:**
  * AAA and TAAA morphology assessment and access vessel evaluation; see [[Aneurysmal Diseases|Ch. 4]] for measurement standards and repair thresholds.thresholds [@aha2022-f].
  * endovascular aneurysm repair (EVAR) and TEVAR planning and surveillance.
  * Carotid and aortic arch assessment; see [[Cerebrovascular Disease|Ch. 7]] for carotid imaging protocols.
  * Peripheral arterialartery disease mapping.(PAD) mapping for revascularization planning [@svs2024-k].
* **Surveillance protocols:** Baseline computed tomography angiography (CTA)CTA at 30 days post-procedure, follow-up at 12 months, then individualized surveillance based on aneurysm sac behavior and endoleak status.status [@aha2022-f]. Consider duplex ultrasound or contrast-enhanced ultrasound (CEUS) in patients with stable anatomy or renal insufficiency.
* **Limitations:** Ionizing radiation exposure and iodinated contrast risks (nephropathy, allergic reactions).
* **Guidelines:** ESVS AAA (2019) and(2019), ESVS carotid (2018)(2018), and the 2022 ACC/AHA Aortic Disease guidelines [@aha2022-f] [@aha2023-b] recommend CTA as a primary planning tool, with aneurysm and post-repair imaging surveillance tailored to patient and device factors. The 2024 ACC/AHA PAD guideline [@svs2024-k] recommends CTA for anatomic characterization when revascularization is considered. [@sun2011] [@esvs2019-aaa] [@esvs2018-esvs] [@svs2018] [@evar2019]
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